In June 2014, the Government of India (GOI) published the policy guidelines, Use of Antenatal Corticosteroids in Preterm Labour, (Under Specific Conditions by Auxiliary Nurse Midwives), Operational Guidelines. With the release of this policy the Ministry of Health and Family Welfare (MOHFW)/ GOI is rolling out antenatal corticosteroids (ACS) including support for auxiliary nurse midwives (ANMs) to administer a pre-referral dose of ACS to pregnant women in preterm labor at public health facilities. Both the India Newborn Action Plan (INAP), and the WHO Recommendations on Interventions to Improve Preterm Birth Outcomes acknowledge the benefit of ACS. The WHO recommendations lay out that ACS therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met:
- Gestational age assessment can be accurately undertaken;
- Preterm birth is considered imminent (within 7 days);
- There is no clinical evidence of maternal infection;
- Adequate childbirth care is available (including the core functions of emergency obstetric care); and
- The preterm newborn can receive adequate care if needed (including resuscitation, thermal care, feeding support, infection treatment and safe oxygen use).
The implementation of the GOI policy guidelines provides a timely opportunity to identify the essential preconditions within the health system for the implementation of a safe and effective ACS program from the PHCU to the district hospital. The MOHFW has requested Every Preemie to assess the current implementation of ACS in two districts in Haryana State and Every Preemie envisions three phases of engagement:
Phase 1: The first phase includes the development of the assessment protocol and tools, IRB approvals in the US and India, and the implementation of the assessment of utilization and practice of ACS administration.
Phase 2: The second phase focuses on convening the GOI Project Advisory Group to review the assessment findings and to support the development of revised national ACS operational guidelines.
Phase 3: The third and final phase of the implementation research focuses on an evaluation of the use of the revised operational guidelines for ACS use in target facilities in the districts of Hisar and Ambala. This phase includes the design of training materials and provider orientation in targeted facilities in the study districts; implementation of the revised national ACS operational guidelines in targeted facilities; design of an evaluation protocol and associated tools for IRB review and approval in the US and in India; the implementation of the evaluation; data analysis; a stakeholder meeting to review evaluation findings; and the submission of a final report of findings and future recommendations.